DEPARTMENT OF INSURANCE
Affiliations
NameAvantax Insurance Services IncDOIID399632NAIC NPN963731
License - Line of Authority Information
StatusResidencyClassLine of AuthorityActive DateInactive DateLicense Expiration Date
ActiveNon ResidentAgentVariable Life and Variable Annuities2/12/2002 3/31/2025
ActiveNon ResidentAgentLife10/23/1999 3/31/2025
ActiveNon ResidentAgentHealth10/7/2002 3/31/2025
* If a status Is Pending, Pending Replacement,Or the record displays Affidavit On File, click On them For more details.
Notice: The Department verifies, at the time of application for a Variable Life and Variable Annuity line of authority, that an agent is registered with the Financial Industry Regulatory Authority (FINRA) and the applicant has passed the Series 6 or greater exam. The Department does not verify registration with FINRA after the agent is qualified by the Department to receive the Variable Life and Variable Annuity line of authority. If you have questions about a broker’s FINRA registration status, you should check this status directly with FINRA.

License Renewal Information
ClassInvoice DateResponse Due / Expiration DateResponse Received DatePayment Received DateRenewal Complete
Agent01/15/202503/31/2025   
Appointments with the following Insurers
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
ActiveAllianz Life Insurance Company of North America301791Agent - Health3/10/2016 
ActiveAllianz Life Insurance Company of North America301791Agent - Life11/20/2000 
ActiveAllianz Life Insurance Company of North America301791Agent - Variable Life and Variable Annuities3/10/2016 
ActiveAmerican General Life Insurance Company301585Agent - Life12/6/2012 
ActiveAmerican General Life Insurance Company301585Agent - Variable Life and Variable Annuities12/6/2012 
InactiveAmerican General Life Insurance Company of Delaware301057Agent - Life3/31/200012/27/2012
InactiveAmerican General Life Insurance Company of Delaware301057Agent - Variable Life and Variable Annuities3/11/200212/27/2012
InactiveAmerican National Insurance Company301861Agent - Health8/1/20075/4/2021
ActiveAmerican National Insurance Company301861Agent - Life8/1/2007 
InactiveAmerican National Insurance Company301861Agent - Variable Life and Variable Annuities8/1/20075/4/2021
ActiveBanner Life Insurance Company301696Agent - Life3/12/2009 
ActiveBrighthouse Life Insurance Company301829Agent - Health11/14/2014 
ActiveBrighthouse Life Insurance Company301829Agent - Life12/7/2007 
ActiveBrighthouse Life Insurance Company301829Agent - Variable Life and Variable Annuities12/7/2007 
InactiveC.M. Life Insurance Company301335Agent - Life4/24/200012/5/2019
ActiveEquitable Financial Life Insurance Company300808Agent - Life3/5/2002 
ActiveEquitable Financial Life Insurance Company300808Agent - Variable Life and Variable Annuities3/5/2002 
InactiveEverlake Life Insurance Company300873Agent - Life3/25/20023/8/2013
InactiveEverlake Life Insurance Company300873Agent - Variable Life and Variable Annuities3/25/20023/8/2013
InactiveFidelity & Guaranty Life Insurance Company301359Agent - Life12/11/20003/27/2009
InactiveFirst Penn-Pacific Life Insurance Company301581Agent - Life8/8/200012/12/2008
ActiveFortitude Life Insurance & Annuity Company301503Agent - Life12/17/1999 
ActiveFortitude Life Insurance & Annuity Company301503Agent - Variable Life and Variable Annuities8/30/2002 
InactiveGeneral American Life Insurance Company300280Agent - Health12/15/200311/19/2009
InactiveGeneral American Life Insurance Company300280Agent - Life12/15/200311/19/2009
InactiveGenworth Life and Annuity Insurance Company301276Agent - Health4/14/200312/22/2016
InactiveGenworth Life and Annuity Insurance Company301276Agent - Life4/14/200312/22/2016
InactiveGenworth Life and Annuity Insurance Company301276Agent - Variable Life and Variable Annuities4/14/200312/22/2016
InactiveGlenbrook Life and Annuity Company301384Agent - Life3/25/20021/1/2005
InactiveGlenbrook Life and Annuity Company301384Agent - Variable Life and Variable Annuities3/25/20021/1/2005
InactiveGolden Rule Insurance Company301943Agent - Health10/7/200212/13/2016
InactiveGolden Rule Insurance Company301943Agent - Life5/15/200212/14/2016
InactiveGuardian Insurance & Annuity Company Inc. (The)301920Agent - Life4/23/201512/6/2022
InactiveGuardian Insurance & Annuity Company Inc. (The)301920Agent - Variable Life and Variable Annuities4/23/201512/6/2022
ActiveIllinois Mutual Life Insurance Company301479Agent - Health2/11/2009 
ActiveIllinois Mutual Life Insurance Company301479Agent - Life2/11/2009 
InactiveJackson National Life Insurance Company300486Agent - Life7/28/20036/1/2020
InactiveJackson National Life Insurance Company300486Agent - Variable Life and Variable Annuities7/28/20036/1/2020
InactiveJefferson National Life Insurance Company300258Agent - Life7/24/20016/8/2006
InactiveJohn Hancock Life Insurance Company300821Agent - Health3/20/200312/30/2009
InactiveJohn Hancock Life Insurance Company300821Agent - Life9/25/200012/30/2009
InactiveJohn Hancock Life Insurance Company300821Agent - Variable Life and Variable Annuities10/17/200212/30/2009
ActiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Health12/30/2009 
ActiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Life12/30/2009 
ActiveJohn Hancock Life Insurance Company (U.S.A.)300132Agent - Variable Life and Variable Annuities2/12/2002 
InactiveJohn Hancock Variable Life Insurance Company301914Agent - Life9/25/20002/19/2009
InactiveJohn Hancock Variable Life Insurance Company301914Agent - Variable Life and Variable Annuities10/17/20022/19/2009
InactiveLife Investors Insurance Company of America301793Agent - Health10/7/20025/17/2005
InactiveLife Investors Insurance Company of America301793Agent - Life10/7/20025/17/2005
InactiveLincoln Benefit Life Company301110Agent - Health10/4/20067/14/2014
InactiveLincoln Benefit Life Company301110Agent - Life10/4/20067/14/2014
InactiveLincoln Benefit Life Company301110Agent - Variable Life and Variable Annuities10/4/20067/14/2014
ActiveLincoln National Life Insurance Company (The)301382Agent - Life11/9/2001 
ActiveLincoln National Life Insurance Company (The)301382Agent - Variable Life and Variable Annuities3/1/2002 
InactiveMassachusetts Mutual Life Insurance Company300445Agent - Life4/24/200012/5/2019
InactiveMetLife Investors Insurance Company301872Agent - Health5/19/200811/14/2014
InactiveMetLife Investors Insurance Company301872Agent - Life5/19/200811/14/2014
InactiveMetLife Investors Insurance Company301872Agent - Variable Life and Variable Annuities5/19/200811/14/2014
InactiveMetLife Investors USA Insurance Company300845Agent - Health2/5/200411/14/2014
InactiveMetLife Investors USA Insurance Company300845Agent - Life2/5/200411/14/2014
InactiveMetLife Investors USA Insurance Company300845Agent - Variable Life and Variable Annuities2/5/200411/14/2014
InactiveMetLife Life and Annuity Company of Connecticut301593Agent - Life11/24/200412/7/2007
InactiveMetLife Life and Annuity Company of Connecticut301593Agent - Variable Life and Variable Annuities11/24/200412/7/2007
ActiveMetropolitan Life Insurance Company301948Agent - Health9/17/2004 
ActiveMetropolitan Life Insurance Company301948Agent - Life9/17/2004 
ActiveMetropolitan Life Insurance Company301948Agent - Variable Life and Variable Annuities5/20/2008 
InactiveMutual of Omaha Insurance Company301012Agent - Health2/12/200312/26/2012
InactiveNationwide Life Insurance Company300495Agent - Life11/30/200012/31/2019
InactiveNationwide Life Insurance Company300495Agent - Variable Life and Variable Annuities2/12/200212/31/2019
InactivePacific Life Insurance Company301848Agent - Life8/6/200312/12/2019
InactivePacific Life Insurance Company301848Agent - Variable Life and Variable Annuities8/6/200312/12/2019
InactivePan-American Assurance Company301533Agent - Life1/17/20022/1/2005
InactivePan-American Life Insurance Company301530Agent - Life1/17/20022/1/2005
ActivePenn Insurance and Annuity Company300712Agent - Life8/7/2000 
ActivePenn Insurance and Annuity Company300712Agent - Variable Life and Variable Annuities4/15/2009 
ActivePenn Mutual Life Insurance Company301394Agent - Life8/7/2000 
ActivePenn Mutual Life Insurance Company301394Agent - Variable Life and Variable Annuities4/15/2009 
InactivePeoples Benefit Life Insurance Company301895Agent - Life2/7/200710/1/2007
InactivePeoples Benefit Life Insurance Company301895Agent - Variable Life and Variable Annuities2/7/200710/1/2007
ActivePrincipal Life Insurance Company300129Agent - Health12/2/2010 
ActivePrincipal Life Insurance Company300129Agent - Life10/15/2001 
ActivePrincipal National Life Insurance Company301926Agent - Life3/10/2020 
InactivePruco Life Insurance Company300954Agent - Health9/17/200712/21/2022
ActivePruco Life Insurance Company300954Agent - Life6/21/2023 
InactivePruco Life Insurance Company300954Agent - Variable Life and Variable Annuities9/17/200712/21/2022
InactiveReassure America Life Insurance Company301902Agent - Life10/23/19999/3/2004
InactiveSecurity Life of Denver Insurance Company300648Agent - Life6/26/20009/29/2012
InactiveStandard Insurance Company300185Agent - Life10/16/200112/5/2022
ActiveState Life Insurance Company301497Agent - Health9/22/2020 
ActiveState Life Insurance Company301497Agent - Life9/22/2020 
ActiveSun Life Assurance Company of Canada301811Agent - Life2/27/2004 
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Life4/10/200712/31/2012
InactiveSunAmerica Annuity and Life Assurance Company301930Agent - Variable Life and Variable Annuities4/10/200712/31/2012
InactiveSunAmerica Life Insurance Company300096Agent - Life12/31/201212/31/2012
InactiveSunAmerica Life Insurance Company300096Agent - Variable Life and Variable Annuities12/31/201212/31/2012
ActiveTalcott Resolution Life Insurance Company301759Agent - Health9/10/2008 
ActiveTalcott Resolution Life Insurance Company301759Agent - Life11/14/2000 
ActiveTalcott Resolution Life Insurance Company301759Agent - Variable Life and Variable Annuities7/12/2002 
ActiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Health9/10/2008 
ActiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Life11/14/2000 
ActiveTalcott Resolution Life and Annuity Insurance Company300932Agent - Variable Life and Variable Annuities9/18/2002 
ActiveTransamerica Life Insurance Company300571Agent - Health10/1/2008 
InactiveTransamerica Life Insurance Company300571Agent - Life1/8/200310/21/2020
InactiveTransamerica Life Insurance Company300571Agent - Variable Life and Variable Annuities1/8/200310/21/2020
InactiveTransamerica Occidental Life Insurance Company300966Agent - Health6/2/200810/1/2008
InactiveTransamerica Occidental Life Insurance Company300966Agent - Life8/9/200010/1/2008
InactiveTransamerica Occidental Life Insurance Company300966Agent - Variable Life and Variable Annuities6/2/200810/1/2008
InactiveTransamerica Premier Life Insurance Company300558Agent - Life10/1/20072/27/2013
InactiveTransamerica Premier Life Insurance Company300558Agent - Variable Life and Variable Annuities10/1/20072/27/2013
InactiveUnited of Omaha Life Insurance Company300156Agent - Health12/12/200812/26/2012
InactiveUnited of Omaha Life Insurance Company300156Agent - Life12/12/200812/26/2012
InactiveVenerable Insurance and Annuity Company301006Agent - Life8/5/20055/18/2018
InactiveVenerable Insurance and Annuity Company301006Agent - Variable Life and Variable Annuities8/5/20055/18/2018
InactiveVoya Retirement Insurance and Annuity Company300643Agent - Health2/2/200912/18/2015
InactiveVoya Retirement Insurance and Annuity Company300643Agent - Life2/2/200912/18/2015
InactiveVoya Retirement Insurance and Annuity Company300643Agent - Variable Life and Variable Annuities2/2/200912/18/2015
InactiveWest Coast Life Insurance Company301607Agent - Life5/20/200411/16/2011
InactiveWestern Reserve Life Assurance Company of Ohio300760Agent - Health10/22/200810/27/2010
InactiveWestern Reserve Life Assurance Company of Ohio300760Agent - Life10/22/200810/27/2010
InactiveWestern Reserve Life Assurance Company of Ohio300760Agent - Variable Life and Variable Annuities10/22/200810/27/2010
InactiveWilco Life Insurance Company300122Agent - Life4/16/20016/21/2010
InactiveZurich American Life Insurance Company300216Agent - Life5/25/20007/13/2011
Designated Individuals
StatusAffiliation NameDOI NumberLine of AuthorityActive DateInactive Date
InactiveAdams, Matthew Taylor 522627Agent - Health4/26/201012/24/2018
InactiveAdams, Matthew Taylor 522627Agent - Life4/26/201012/24/2018
InactiveAdams, Matthew Taylor 522627Agent - Variable Life and Variable Annuities4/26/201012/24/2018
ActiveAllen, Jason 1192773Agent - Health8/21/2023 
ActiveAllen, Jason 1192773Agent - Life8/21/2023 
ActiveAllen, Jason 1192773Agent - Variable Life and Variable Annuities8/21/2023 
InactiveAnneken, David L 507447Agent - Life3/4/20023/1/2019
InactiveAnneken, David L 507447Agent - Variable Life and Variable Annuities3/4/20023/1/2019
DeniedBarnett, David 1205493Agent - Health  
DeniedBarnett, David 1205493Agent - Life  
DeniedBarnett, David 1205493Agent - Variable Life and Variable Annuities  
InactiveBatman, Stephen Anthony 363572Agent - Health10/7/20025/17/2019
InactiveBatman, Stephen Anthony 363572Agent - Life10/23/19995/17/2019
InactiveBatman, Stephen Anthony 363572Agent - Variable Life and Variable Annuities2/12/20025/17/2019
InactiveCammack, Marcia Johnson 503524Agent - Life3/4/20022/25/2003
InactiveCammack, Marcia Johnson 503524Agent - Variable Life and Variable Annuities3/4/20022/25/2003
InactiveCounts, Kevin Dale 341461Agent - Health1/30/20045/17/2019
InactiveCounts, Kevin Dale 341461Agent - Life1/30/20045/17/2019
InactiveCounts, Kevin Dale 341461Agent - Variable Life and Variable Annuities1/30/20045/17/2019
InactiveDonald, Douglas 534101Agent - Health7/15/20034/28/2018
ActiveDonald, Douglas 534101Agent - Life7/15/2003 
ActiveDonald, Douglas 534101Agent - Variable Life and Variable Annuities7/15/2003 
InactiveErhard, David Anthony 547579Agent - Health2/3/20055/31/2005
InactiveErhard, David Anthony 547579Agent - Life2/3/20055/31/2005
InactiveErhard, David Anthony 547579Agent - Variable Life and Variable Annuities2/3/20055/31/2005
InactiveEvans, Lisa R 308348Agent - Life3/4/20029/1/2023
InactiveEvans, Lisa R 308348Agent - Variable Life and Variable Annuities3/4/20029/1/2023
DeniedGagel, Marlene Elizabeth 728610Agent - Health  
DeniedGagel, Marlene Elizabeth 728610Agent - Life  
DeniedGagel, Marlene Elizabeth 728610Agent - Variable Life and Variable Annuities  
InactiveJones, Michael B 509132Agent - Life3/4/20021/30/2004
InactiveJones, Michael B 509132Agent - Variable Life and Variable Annuities3/4/20021/30/2004
InactiveJorgensen, Michael 364408Agent - Health8/26/20214/30/2023
InactiveJorgensen, Michael 364408Agent - Life6/3/20214/30/2023
InactiveJorgensen, Michael 364408Agent - Variable Life and Variable Annuities6/3/20214/30/2023
PendingKing, David 965089Agent - Health  
PendingKing, David 965089Agent - Life  
PendingKing, David 965089Agent - Variable Life and Variable Annuities  
DeniedLivingston, Michael Anthony 689089Agent - Health  
InactiveLivingston, Michael Anthony 689089Agent - Life10/7/20085/17/2019
InactiveLivingston, Michael Anthony 689089Agent - Variable Life and Variable Annuities10/7/20085/17/2019
InactiveMelton, Ricky Lane 579830Agent - Health3/15/200412/7/2010
InactiveMelton, Ricky Lane 579830Agent - Life3/15/200412/7/2010
InactiveMelton, Ricky Lane 579830Agent - Variable Life and Variable Annuities3/29/200412/7/2010
InactiveOeth, Linda J 382495Agent - Health2/3/20052/12/2007
InactiveOeth, Linda J 382495Agent - Life2/3/20052/12/2007
InactiveOeth, Linda J 382495Agent - Variable Life and Variable Annuities2/3/20052/12/2007
InactivePagano, Michael Anthony 367490Agent - Health5/17/20191/1/2023
InactivePagano, Michael Anthony 367490Agent - Life5/17/20191/1/2023
InactivePagano, Michael Anthony 367490Agent - Variable Life and Variable Annuities5/17/20191/1/2023
PendingPolston, Jordan Franklin 1336158Agent - Health  
PendingPolston, Jordan Franklin 1336158Agent - Life  
PendingPolston, Jordan Franklin 1336158Agent - Variable Life and Variable Annuities  
InactiveRajala, Jessica 1280118Agent - Health7/3/202311/27/2023
InactiveRajala, Jessica 1280118Agent - Life8/30/202311/27/2023
ActiveRajala, Jessica 1280118Agent - Variable Life and Variable Annuities8/30/2023 
InactiveSolt, Timothy S 547576Agent - Health2/3/20058/31/2005
InactiveSolt, Timothy S 547576Agent - Life2/3/20058/31/2005
InactiveSolt, Timothy S 547576Agent - Variable Life and Variable Annuities2/3/20058/31/2005
DeniedTuten, Matthew 1271087Agent - Health  
DeniedTuten, Matthew 1271087Agent - Life  
DeniedTuten, Matthew 1271087Agent - Variable Life and Variable Annuities  
InactiveWilliams, Steven G 322741Agent - Health6/28/20048/31/2015
InactiveWilliams, Steven G 322741Agent - Life6/28/20048/31/2015
InactiveWilliams, Steven G 322741Agent - Variable Life and Variable Annuities6/28/20048/31/2015
InactiveWright, Marvin James 544322Agent - Health2/3/20056/30/2015
InactiveWright, Marvin James 544322Agent - Life2/3/20056/30/2015
InactiveWright, Marvin James 544322Agent - Variable Life and Variable Annuities2/3/20056/30/2015

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